NCC190566_NOI Application_20190610

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/10/2019 3:54:34 PM (NCG01 NOI Submission)
Approve by Morman, Alaina 6/11/2019 8:56:52 AM (Review- Construction NOI 12012)
• The task was assigned to Morman, Alaina by round robin distribution 6/10/2019 3:54 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: June 12, 2019 5:00 PM
6/10/2019 3:54 PM
Submit by Morman, Alaina 6/11/2019 9:05:56 AM (Payment Verification - NCG01-2019-0566)
• The task was assigned to Morman, Alaina. The due date is: June 12, 2019 5:00 PM
6/11/2019 8:57 AM

STME
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
1re) frIT7i)Mfi1if_T1IIa1010
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Holden Creek Preserve Phase !a Lots 99,127,and 135
2. County* Franklin
3. Highway or Street Holden Forest Drive and Holden Creek Drive
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Youngsville
5. State * NC
6. Zip Code* 27596
7. Latitude * Enter the latitude in decirral degrees
36.0229
8. Longitude * Enter the longitude in decirral degrees (MIST be negative)
-78.4912
If you do not know the latitude and longitude coordinates for this project, you can search the location on this map of
North Carolina. Look for the coordinates in the bottom left corner.
9. Date to Begin*
06/04/2019
Estimated Construction Project Start Date
10. Date to End*
06/04/2020
Estimated Construction Project End Date
11. SIC (Primary)*
Residential, Single
Family Houses (SFE)
(1521)
Standard Industrial aassification for Development
12. Acres to be
0.56
disturbed*
(including off -site borrow and waste areas)
13. Total site area 0.56
(acres)*
14. Post- 0.27
construction (Estimated)
impervious area
(acres) *

NCC Project NCC-FRANK-2019-Holden Creek Preserve Phase !a Lots
Tracking ID 99,127,and 135
Assigned autorratically
Below you must enter waterbody information for surface waters affected by this project. Please consult
DWR's Surface Water Classifications Map Viewer to find waterbody name and corresponding index number. You may
enter up to 3 waterbodies.
15a. Receiving Richland Creek
Wate rbody* Narre of waterbody into which storrrwater runoff will discharge
15b. Waterbody 27-21-(0.5)
Index No. * NC Waterbody Index Ninber
Stormwater PF No
discharges will flow r Yes
to additional
wate rs *
16a. Is this project F Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*

B. Permittee Information
Part B.
Rerrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application
form should be the same person as listed in THIS SECTION, or an authorized responsible individual within the same
organization. That person must be a responsible corporate officer who owns or operates the construction activity, such
as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV,
Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
1. Organization Caviness & Cates Building and Development Company
Name *
2. First Name* Christopher
ff Corporation, enter Registered Agent First kbrre
3. Last Name * Cates
ff Corporation, enter Registered Agent Last Barre
3b. Title Vice President
4. Permitee E-mail [e-mail]
Address*
5. Permittee 910-778-7902
Telephone No.*
6. Permittee Mailing Street Address
Address* 639 Executive Place
Address Line 2
City
Fayetteville
Rastal / Zip Code
28305
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
fJ Yes
Street Address
639 Executive Place
Address Line 2
City
Fayetteville
Rastal / Zip Code
28305
State / Province / Region
NC
Country
us
State / Province / Region
NC
Country
us

C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of Non -Government
Ownership*
2. Primary Site Stan
Contact - First
Name *
3. Primary Site Klesta
Contact - Last
Name *
4. Title Project Manager
5. Site Contact E- [e-mail]
mail Address*
6. Site Contact 910-322-6214
Telephone No.*
7. Organization Caviness & Cates Building and Development
Name Company
8. Site Contact Street Address
Mailing Address* 639 Executive Place
Address Line 2
Cty
State / Province / Region
Fayetteville
NC
Fbstal / Zip Code
Country
28305
us

D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 06/04/2019
Approved *
2. E&SC Plan Project FRANK- 2019-030
Number/ID* Assigned by agency or local program
3. E&SC Plan f• State DEQ Office
Approved by r Local Program
4. State DEQ Office * Raleigh (RRO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application.
5. E&SC Plan Holden Creek Erosion Approval Lots # 99,127,and
Approval 68.77KB
135. pdf
letter/documentation
Mist be R7F format
6. NOI Certification Holden Creek signed NOI.pdf 43.91KB
Form Mist be RDF format
This is an Express f• No
Review Project* r Yes

E. Certification
North Carolina General Statute 143-215.613 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
rJ I am the person responsible for the construction activities of this project, for
satisfying the requirements of this permit, and for any civil or criminal penalties
incurred due to violations of this permit.
* rJ The information submitted in this NOI is, to the best of my knowledge and belief,
true, accurate, and complete based on my inquiry of the person or persons who
manage the system, or those persons directly responsible for gathering the
information.
* I7 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* rJ I hereby request coverage under the NCG010000 General Permit and
understand that coverage under this permit will constitute the permit
requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
Specify if you are:* r The Responsible Person named on this Notice of Intent
r Authorized Responsible Person*
Important: The person who signs this Certification above and signs the NOI Certification Form should be the same
person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information)
of this form. *An authorized individual is a responsible corporate officer who owns or operates the construction activity,
such as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV,
Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
Signature
Type Name * Christopher E. Cates
Title Vice President
Organization Caviness & Cates Building and Development Company
Date * 06/10/2019

F. Tracking and COC Info
NOI Tracking No. 12012
NC Reference No. NCG01-2019-0566
Uses 'count number variable (incremrented by SP)
Certificate of NCC190566
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 566
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)